Abstract 9474: Clinical and Epidemiologic Characterization of Infective Endocarditis in a Predominant Hispanic Community of the United States - Mexico Border

Abstract

Introduction: We aimed to characterize the clinical, epidemiological and echocardiographic features of infective endocarditis (IE) in the United States (US)-Mexico border population. Methods: A retrospective cohort design of all patients with diagnosis of IE in a tertiary university health system in El Paso, Texas. The primary outcome was a composite of death, stroke, other embolic events or heart failure. Patients were risk-stratified using the Simplified Risk Score Calculation (scores >=5 were considered high risk). Kaplan-Meier method was used to evaluate time to outcome which was subsequently compared between groups by Wilcoxon log-rank test and a priori multivariable proportional hazard model. Results: Final analytic sample was 155 patients with a median follow-up of 2.21 years. Prosthetic valve IE composed 10.3% of our patients. The most prevalent organism was S. aureus (35.5%), followed by streptococcus species (20.0%). Echocardiographic features of severe endocarditis (indication of surgery) were present in 123 patients (79.5%). Surgical treatment occurred in 23.2% of patients, and the median time to surgery was 12 days. A total of 53% of patients were in the high-risk score category and these patients were more likely to have a conservative, medical treatment compared to those with a low to intermediate risk score (62.2% vs 37.8%, p<0.01). The composite outcome was met by 47.5% of our cohort. Median time to event was 69 days. In multivariable analysis, factors associated with increased risk of the composite outcome were high-risk score category (HR 2.6, 95%CI 1.6-4.3, p<0.01), Medicaid (HR 3.2, 95%CI 1.6-6.2, p<0.01) and uninsured status (HR 2.3, 95%CI 1.3-4.3, p<0.01). Conclusion: In a predominant Hispanic community of the US-Mexico border, high-risk IE patients were more likely to experience the composite outcome, and less likely to get surgical treatment. In multivariable analysis, uninsured patients had a significant higher risk of readmission, embolic events, heart failure or death.